A National Physician Survey of Deintensifying Diabetes Medications for Older Adults With Type 2 Diabetes

Diabetes Care. 2023 Jun 1;46(6):1164-1168. doi: 10.2337/dc22-2146.

Abstract

Objective: To determine physicians' approach to deintensifying (reducing/stopping) or switching hypoglycemia-causing medications for older adults with type 2 diabetes.

Research design and methods: In this national survey, U.S. physicians in general medicine, geriatrics, or endocrinology reported changes they would make to hypoglycemia-causing medications for older adults in three scenarios: good health, HbA1c of 6.3%; complex health, HbA1c of 7.3%; and poor health, HbA1c of 7.7%.

Results: There were 445 eligible respondents (response rate 37.5%). In patient scenarios, 48%, 4%, and 20% of physicians deintensified hypoglycemia-causing medications for patients with good, complex, and poor health, respectively. Overall, 17% of physicians switched medications without significant differences by patient health. One-half of physicians selected HbA1c targets below guideline recommendations for older adults with complex or poor health.

Conclusions: Most U.S. physicians would not deintensify or switch hypoglycemia-causing medications within guideline-recommended HbA1c targets. Physician preference for lower HbA1c targets than guidelines needs to be addressed to optimize deintensification decisions.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Blood Glucose
  • Diabetes Mellitus, Type 2* / drug therapy
  • Glycated Hemoglobin
  • Humans
  • Hypoglycemia* / drug therapy
  • Hypoglycemic Agents / therapeutic use
  • Physicians*

Substances

  • Glycated Hemoglobin
  • Blood Glucose
  • Hypoglycemic Agents